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Hip Impingement/ FAI/ Hip Surgery

  • 16-06-2020 4:23pm
    #1
    frebel
    Registered Users Posts: 108 ✭✭


    Anyone with any experience or advice on hip impingement.... Looks like I have FAI and the next step is to see an ortho surgeon with Patrick Carton's name coming quite a bit... anyone have any experiences or recommendations? PM me if you would prefer

    Any help really appreciated...


Comments

  • #2
    Ceepo
    Registered Users Posts: 2,508 ✭✭✭Ceepo


    frebel wrote: »
    Anyone with any experience or advice on hip impingement.... Looks like I have FAI and the next step is to see an ortho surgeon with Patrick Carton's name coming quite a bit... anyone have any experiences or recommendations? PM me if you would prefer

    Any help really appreciated...
    What steps have you taken firstly to diagnosis your problem and secondly to passively Rehab your issues.
    Have you looked into the success and return to sport rate after surgery.


  • #3
    frebel
    Registered Users Posts: 108 ✭✭frebel


    Ceepo wrote: »
    What steps have you taken firstly to diagnosis your problem and secondly to passively Rehab your issues.
    Have you looked into the success and return to sport rate after surgery.

    Hi Ceepo, just got MRI results back and there are a few issues but seems to be clear there is a FAI which has meant that despite doing 6 weeks of physio-led rehab twice a day, an easy 15 mins of walk/ jog leads to 2 days of pain.

    GP has recommended no weigh-bearing short-term but to see ortho surgeon asap to assess more closely...

    I'm not rushing to jump into anything but looks like I'll have to stick to cycling for a while but quality of life is something that I feel is being affected now when I can't even go for a jog without 2 days of pain after


  • #4
    Ceepo
    Registered Users Posts: 2,508 ✭✭✭Ceepo


    frebel wrote: »
    Hi Ceepo, just got MRI results back and there are a few issues but seems to be clear there is a FAI which has meant that despite doing 6 weeks of physio-led rehab twice a day, an easy 15 mins of walk/ jog leads to 2 days of pain.

    GP has recommended no weigh-bearing short-term but to see ortho surgeon asap to assess more closely...

    I'm not rushing to jump into anything but looks like I'll have to stick to cycling for a while but quality of life is something that I feel is being affected now when I can't even go for a jog without 2 days of pain after

    Sorry to hear that it is causing pain.

    A contributing factor to FAI is compression and trauma in hip flexion, this can be caused in some cases from the hip anteriorly tilting, Any Rehab that you have done should include exercises to address this.
    What did your Rehab program include.?
    If you decide to go ahead wit an op, make sure that you address APT otherwise you'll end up in a similar situation


  • #5
    frebel
    Registered Users Posts: 108 ✭✭frebel


    Thanks Ceepo
    This was rehab prior to getting MRI report
    (have weak hamstring on affected side as well so that influenced rehab)


    Clamshells
    Band-walks (Crab)
    Hip Hitches
    SL Balance with Squats
    Resisted Hip Flexion (on affected side)
    SL Bridges
    Resisted Hamstring Curl
    Standing Hip Extension

    Would have done a lot of deadbugs and superman raises myself in addition

    Also, variety of neck and shoulder exercises as they had been affected as well...On top of all this, I have 2 very dodgy achilles!

    I won't add my achilles tendonopathy programme which I'm now thinking stemmed from dodgy hip! :(

    Sounds really bad now that I've written it all down!


  • #6
    Ceepo
    Registered Users Posts: 2,508 ✭✭✭Ceepo


    frebel wrote: »
    Thanks Ceepo
    This was rehab prior to getting MRI report
    (have weak hamstring on affected side as well so that influenced rehab)


    Clamshells
    Band-walks (Crab)
    Hip Hitches
    SL Balance with Squats
    Resisted Hip Flexion (on affected side)
    SL Bridges
    Resisted Hamstring Curl
    Standing Hip Extension

    Would have done a lot of deadbugs and superman raises myself in addition

    Also, variety of neck and shoulder exercises as they had been affected as well...On top of all this, I have 2 very dodgy achilles!

    I won't add my achilles tendonopathy programme which I'm now thinking stemmed from dodgy hip! :(

    Sounds really bad now that I've written it all down!

    Without seeing you in person or at least seeing your standing posture it would be impossible for me to say whether you're in Apt.
    You're probably right about them all being connected. If you are in atp, usually when people find it hard to get good hip extension. The reason hamstring test weak is because the are in a lengthened position. When you can't get good hip extensions then the calves overwork to help "push" forward rather than the glue working. Doing glute and hamstring strength work while it seems a good idea, they will never work properly if they're in a lengthen position. Also working on quad strength will only serve to maintain the balance that you currently have.

    I hope some of that makes some sense to you


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  • #7
    frebel
    Registered Users Posts: 108 ✭✭frebel


    Ceepo wrote: »
    Without seeing you in person or at least seeing your standing posture it would be impossible for me to say whether you're in Apt.
    You're probably right about them all being connected. If you are in atp, usually when people find it hard to get good hip extension. The reason hamstring test weak is because the are in a lengthened position. When you can't get good hip extensions then the calves overwork to help "push" forward rather than the glue working. Doing glute and hamstring strength work while it seems a good idea, they will never work properly if they're in a lengthen position. Also working on quad strength will only serve to maintain the balance that you currently have.

    I hope some of that makes some sense to you

    Yeah, does alright... been looking at some of the exercises today


    which is research led http://bjsm.bmj.com/content/bjsports/50/19/1217.full.pdf

    do you think apt can be such a strong factor for hip injury? fai (bone) v muscle would seem a stronger reason for me (but have no qualifications in this area)


  • #8
    Ceepo
    Registered Users Posts: 2,508 ✭✭✭Ceepo


    frebel wrote: »
    Yeah, does alright... been looking at some of the exercises today


    which is research led http://bjsm.bmj.com/content/bjsports/50/19/1217.full.pdf

    do you think apt can be such a strong factor for hip injury? fai (bone) v muscle would seem a stronger reason for me (but have no qualifications in this area)

    Were any of these exercises part of what Rehab protocol that you followed.?

    If you can picture the head of the femur bone (big round bit) and the way it sits in the socket. In a neutral position this has the ability to forward back and side to side. If the hip angle changes (atp) then the range of motion is is not the same. It will have less room to travel before it meets its end of range. Also because the position is not optimal, there will be higher compression force place on it during the gait cycle..
    You need to release psoas and rec fem muscles, retention the hamstring and activate the glutes when in motion.
    It's not enough just to strengthen them alone unless they work when they should.


  • #9
    frebel
    Registered Users Posts: 108 ✭✭frebel


    Ceepo wrote: »
    Were any of these exercises part of what Rehab protocol that you followed.?

    If you can picture the head of the femur bone (big round bit) and the way it sits in the socket. In a neutral position this has the ability to forward back and side to side. If the hip angle changes (atp) then the range of motion is is not the same. It will have less room to travel before it meets its end of range. Also because the position is not optimal, there will be higher compression force place on it during the gait cycle..
    You need to release psoas and rec fem muscles, retention the hamstring and activate the glutes when in motion.
    It's not enough just to strengthen them alone unless they work when they should.
    Thanks again Ceepo
    Physio had assumed glute med was main cause of instability...

    Do you have suggestions for apt routine? Trying to be more mindful throughout day now as well


  • #10
    Ceepo
    Registered Users Posts: 2,508 ✭✭✭Ceepo


    frebel wrote: »
    Thanks again Ceepo
    Physio had assumed glute med was main cause of instability...

    Do you have suggestions for apt routine? Trying to be more mindful throughout day now as well

    Hi.
    As I said in the previous post. On the front, You need to release the psoas muscle and the rec fem muscle. Because these cross the hip complex they can "pull" the the spine closer to the femur which is effect anterior pelvic tilt.. But then you need to address the balance between the back and front. Building strength imo in the glutes is worthless unless you address the Atp because the glute CANNOT work properly in a lengthened position. You will also need to retention the hamstrings to help "pull" the pelvis posteriorly.

    As I said atp can be a contributing factor but not the only one.
    Some people have a rotation of the hip as they walk or run. This can also play a part as the femoral head is rotating in the socket while weight bearing. The hip can allow for this but it's not optimal for hip health..

    If you want you feel free to pm me. I'm more than willing to help you out. But I'm sure you can understand why I'd be reculant to on a public forum.


  • #11
    frebel
    Registered Users Posts: 108 ✭✭frebel


    My post yesterday should have gone here...

    Just to give an update with the injury...

    Have cancelled the surgery appt and back running!
    Even though my GP (who is brilliant and a former physio) and 2 physios strongly suggested surgery was the best option, I've ironed out other issues which has greatly reduced the hip pain.

    I'm not 100% yet but back doing strides and reps at tempo pace as well as hours and hours of cycling which is a crazy turnaround within 4 weeks. Someday, who knows, I may have to get surgery, but the longer I can delay it the better.

    Having dealt with FCE and Ceepo over the last few weeks I would be very reluctant to go to a physio again... there seems to a be a few people out there offering alternatives (anthony claffey, movement 101 etc) that have to be worth a consideration ahead of going 'under the knife'

    In my experience, a lot of physios just deal with the issue in front of them instead of looking at the whole picture and 'why' things are happening. In contrast, Ceepo is possibly a genius when it comes to figuring out how different issues and traits affect your body... think he might be doing online consults now as well so worth a shout for any recurring injury issues. Either way, I'd have a 2nd/ 3rd/ 4th opinion before going down the surgery route.

    Just said I'd give update as it might give someone some encouragment...(hopefully I won't be back here crying again in a few weeks)


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  • #12
    Belkin1975
    Registered Users Posts: 34 ✭Belkin1975


    https://www.boards.ie/discussion/comment/114120499#Comment_114120499

    Hi, I’m not sure if you check this. How has it all gone for you without surgery? My son is 14 and very active and they’re thinking surgery is the route for him.



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